Week 5 - Justin Levine

 For the fifth week of immersion I continued the trend from the past two weeks of, while still shadowing Dr. Spector in the clinic and the OR and continuing to see new and impressive procedures, slowly transitioning into more lab work. While the clinical database retrospective study looking at correlation between bone mineral density and breast cancer bone metastasis, which I detailed in last week’s post, is currently held up as our paperwork applying for IRB approval is reviewed, I made progress in my primary adipose staining work.


We shadowed Dr. Spector as he performed multiple dermal reconstruction surgeries on patients who had just undergone Mohs surgery, a procedure to excise melanoma with clear margins while removing as little tissue as possible. This leads to indentations, sometimes quite large, on patients where cancerous tissue was removed, which Dr. Spector repaired with DermiSphere and plastic surgery suturing techniques. At one procedure on Tuesday I had my closest view yet of DermiSphere - it is effectively a large rectangular collagen hydrogel that can be cut and shaped to fit a wound, and its non-rigid nature allows it to effectively coat nonlinear wound surfaces. Even as someone who studies tissue engineering, with a focus on mechanical and chemical cues affecting cell fate, I find it remarkable how a relatively simple hydrogel formulation can invite such rapid vascular invasion and tissue generation. 


In the clinic, we performed rounds to check in on patients post-operation, which was, as always, very fulfilling - I continue to deeply appreciate being able to see patients recovering well. We also saw the patient I mentioned in my Week 3 post who had undergone the jaw and fibula excision and had a replacement jaw section crafted from the fibula. The patient was doing very well for being just 2 weeks out from an intense operation, already restless and asking when they can get back to the gym. Pooja was able to use CT scans sent to her by Dr. Spector to 3D print the patient’s full jaw, including a cavity where the large cyst was growing, and give it to the patient (this patient had requested to keep all removed bone from the procedure and was disappointed to learn that this violated hospital policy). The patient and their parent were very happy and grateful to receive this, and it felt great to see; the human aspect of healthcare, everything that comes before and after the OR, continues to be my favorite realization of the summer.


In the lab, I modified my staining protocol, and was able to completely digest adipose tissue and then spend less time staining it than I had in the previous iteration. The stain was a success! Phalloidin successfully stained f-actin in the adipocytes, and nuclei were clearly visible (stained with Hoechst 33342). I have identified two areas that need more work: first, images at high magnification on the lab’s microscope are quite blurry, so I will look into whether I can use another lab’s confocal microscope, or perhaps an oil immersion objective; and second, too much sample is lost in successive wash/aspiration steps, so I will work with my lab back in Ithaca to order some dialysis tubing that I think may help in the coming days.

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